Laserfiche WebLink
' CITY OF ORONO �����V�� <br /> BUILDING PERMIT APPLICATION JUN 1 � 2017 <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> �O A, MailiPO Bo�r66 . Permit number. /�'U� <br /> !v� �,/ r <br /> Crystal Bay, MN 55323-0066 � Date received: tl� � ��/ � <br /> StreetAddress:' \`�' Received by: <br /> yF G^ 2750 Kelley Parkway � � Plan review fee: ���, � <br /> CqkESH��� Orono, MN 55356 �Q� ,� 6 �� <br /> Main: 952-249-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: � �(`� • T� ����'� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes o <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will e <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT I�VFORM TION: " <br /> Name: � 1��`� � i���' <br /> State License# �.* _' � Expiration Date: <br /> Phone: cell �'Z„ � ' �' - y office <br /> Mailing Address: . — „� -� Cit : T�dl ZIP: p►� ' �Y <br /> Contact Person: ���� Applic�t is: . Contractor omeowne (Circle One) <br /> Emailand/orFax: �ZG�,,�� �p���v����,������� �y� � � t-G•s1 <br /> PROPERTY OWNER INFOR ATION_ :! T <br /> Name: ��G�l. uf��, �� <br /> Phone (day): ' Z` - „_' ""� <br /> Address: f.._ � Cit : i/� ZIP: `,���� � <br /> Email and/or Fax •M���. �,.1 �-- � � <br /> ARCHITECT/ENGIN ER INFORMATION:(� � �� <br /> Name: �.C`��;L�. I�a,dtl�TC%� <br /> Phone (day): � ��; �., <br /> Address: 'Z.'? G.ve.; � Cit : 1 � ' ZIP: <br /> Email and/or Fax: � � ;$�� � -�,� 4 <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2.Proposed Use 3.Structure Type 4.Sewage Disposal& <br /> Water Supply <br /> ❑ New Construction ❑Single Family with ccessory Bldg./Garage <br /> ❑Addition attached garage Deck ❑ Public Sewer <br /> �Accessory Building ❑ Single Family with ❑Office/Commercial � <br /> Relocation detached garage ❑ Residence ❑ Private Sewer � <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> **Any earth movement may also require ❑Commercial ❑ Storage <br /> MCWD review&permits. Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) Othef: speCify) ❑ Othe�(SpeCify) <br /> 15320 Minnetonka Blvd (�, �,.�� <br /> Minnetonka,MN 55345 IIt`1 (' ��„�+�f�,'�� .� <br /> Phone: 952-471-0590 � �� <br /> Fax: 952-471-0682 <br /> www.m i n neha hacreek.or <br /> Estimated Construction Valuation (excluding land) � '� � ���✓� <br /> Last Updated: January 2016 <br />